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N232 > Module 3: Pain Management > Flashcards

Module 3: Pain Management Flashcards

(117 cards)

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1
Q

what routes can opioids be administered?

A

orally, IV, subQ, intraspinal, rectal, and transdermal

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2
Q

what are the adverse effects of opioids?

A

respiratory depression and sedation, nausea and vomiting, and constipation

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3
Q

what patients are more susceptible to the adverse effects of opioids?

A

patients with undertreated hypothyroidism; may require a larger dose

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4
Q

what patients are more susceptible to the respiratory effects of opioids?

A

patients with dec. respiratory reserve from disease or aging

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5
Q

what does the nurse assess upon the first administration of opioids?

A

BP, heart rate, resps, and pain

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6
Q

what does the nurse do if the pain is not relieved on opioid treatment?

A

assess vitals again and if patient is alert, may need to inc. dose (need a physician to determine this)

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7
Q

what is tolerance in opioid therapy?

A

tolerance develops in patients that have been using opioids to for an extended period of time

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8
Q

what do patients that have a high tolerance to opioids need in order to achieve the therapeutic effects?

A

an increased dose

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9
Q

what are local anesthetics?

A

they block nerve conduction when applied directly to nerve fibers

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10
Q

how can local anesthetics be applied?

A

directly to site or infused around nerve fiber or epidural catheter

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11
Q

what are local anesthetics good for?

A

pain associated with thoracic or upper abdominal surgery when injected by surgens into the intercostal space

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12
Q

when is the spinal administration of local anesthetics used?

A

during surgery or labour and delivery

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13
Q

what else can anti-seizure meds be used for?

A

neuro pain

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14
Q

when is balanced analgesia most effective?

A

when multimodal (use of more than one to obtain more pain relief with few SE)

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15
Q

what is patient-controlled analgesia?

A

used for post-operative pain

- allows pt to self-administer in a safe range

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16
Q

what route of analgesics are preferred in acute care settings?

A

IV (rapid effect)

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17
Q

what is the period of time analgesics are pushed through the IV in acute care?

A

10-15 min period

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18
Q

which patients is subQ good for when giving analgesics?

A

CA pts

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19
Q

what is the preventative approach?

A

when the therapeutic levels are maintained

  • on timed basis instead of waiting for the patient to report pain
  • smaller doses are needed
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20
Q

why is the preventative approach good?

A

reduces the amount of time the pt is in pain

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21
Q

can severe pain be relieved by oral meds?

A

yes, if the dose is high enough

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22
Q

when is the rectal route preferred?

A

for patients with bleeding problems

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23
Q

what are transdermal patches used for in terms of opioids?

A

used to achieve a consistent opioid serum level through absorption of the medication via the skin

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24
Q

what should never be placed on a transdermal patch?

A

a heating pad

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25
where do intraspinal medications get administered?
into sub-arachnoid space or epidural space
26
what is a side effect of intraspinal or epidural meds?
spinal headache (more likely in pts less than 40 years of age)
27
when can respiratory depression occur in intraspinal or epidural administrations?
6-12 hours after administration
28
what is the definition of analgesics?
drugs that relieve pain without causing loss of consciousness
29
what is the definition of opioids?
any drug that's natural or synthetic that has actions similar to those of morphine
30
what are the three main opioid receptors?
Mu, Kappa, Delta
31
what activates Mu receptors?
analgesia, respiratory depression, euphoria, and sedation | - also by physical dependance
32
why are Mu receptors necessary?
to mediate major actions of opioid drugs
33
what can Kappa receptors produce upon activation?
same as Mu - analgesia and sedation
34
what is morphine the prototype of?
strong agonists
35
what is codeine a prototype of?
moderate to strong agonists
36
what is naloxone a prototype of?
purse opioid antagonists
37
what are the effects of morphine?
relieves pain, causes drowsiness/mental clouding, reduces anxiety and creates a sense of well-being
38
what happens with prolonged use of morphine?
produces a tolerance and physical dependence
39
what kind of pain is morphine most effective with?
dull, constant pain
40
what kind of pain is morphine not as effective with?
intermittent & sharp pain
41
what is CRUCIAL to monitor with patients on opioid meds?
level of consciousness, resp. rate, and oxygen saturations
42
how do opioids promote constipation?
promoting Mu receptors in the gut - suppress propulsive intestinal contractions - intensify non-propulsive contractions - increase the tone of the anal sphincter - inhibit secretions of fluid into intestinal lumen
43
how can constipation d/t opioids be managed?
inc. physical activity, inc. intake of fibre and fluids, enema
44
how can morphine affect the urinary system?
can cause inc. UR and urinary hesitancy | - inc. tone of bladder sphincter and inc. tone of detrusor muscle
45
what should you encourage a pt on morphine to do d/t what it does to bladder?
urinate every 4 hours to improve discomfort
46
how does morphine decrease urine production?
decreases renal blood flow and partly by promoting release of antidiuretic hormone
47
how does morphine effect coughs?
it suppresses coughs
48
what do opioids do to the bile ducts?
induce spasm, causing . problems within the biliary tract to rise dramatically
49
how do opioids effect emesis?
- promotes nausea and vomiting | - reduced in pts remaining still
50
what can opioids do to intracranial pressure (ICP)?
increase pressure
51
what is euphoria?
exaggerated sense of well-being
52
what causes euphoria?
Mu receptors
53
what is dysphoria?
a sense of anxiety and unease
54
when is dysphoria common?
when morphine is taken in the absence of pain
55
when is dysphoria uncommon?
when the patient is in pain
56
how can sedation while taking opioids be avoided? (3)
- taking smaller doses more often - using opioids that have short half lives - giving small doses of a CNS morning and early afternoon
57
when can neurotoxicity take place with the use of opioids?
renal impairment, pre-existing cognitive impairmant, prolonged high-dose use
58
what can neurotoxicity cause?
delirium, agitation, myoclonus, hyperalgesia
59
how can you manage neurotoxicity?
hydration and dose reduction
60
what are adverse effects of using opioids long-term?
- hormonal changes | - alter immune system
61
what are some pharmacokentics about opioids?
- poor lipid solubility - doesn't cross the BBB easily - oral doses need to be much larger than parenteral doses to achieve same effects
62
how long does morphine withdrawal syndrome last?
7-10 days
63
what are the 4 routes of fentanyl?
parenteral, transdermal, transmucosal, intranasal
64
what can fentanyl be used for?
surgical analgesia, chronic pain control, and control of break through pain
65
where should a fentanyl patch be applied?
upper torso
66
how long does a fentanyl patch take to reach effective levels?
24 hours
67
how long do drug levels stay steady in a fentanyl patch?
48 hours - should be replaced now
68
in which patients is fentanyl persistent in for severe pain?
patients over 18 and over 110 pounds
69
what happens if you apply heat to a fentanyl patch?
could accelerate fentanyl release
70
how should nurses dispose of fentanyl patches?
folded in half and into the sharps bin
71
what are the 4 formulations of the transmucosal route?
1. lozenges on a stick 2. buccal tablets 3. sublingual tablets 4. sublingual spray
72
when is the transmucosal route used for fentanyl?
in CA patients ONLY
73
what is methadone used for?
to relieve pain and treat opioid addiction
74
what is methadone similar to?
morphine
75
what route is methadone effective and how long?
orally; long duration of action
76
what is hydromorphone similar to?
morphine
77
what is the indication of hydromorphone?
moderate to severe pain
78
what SE can hydromorphone have?
same adverse effects as fentanyl, may cause less nausea than morphine
79
what are moderate to strong opioid agonists important?
produce less analgesia and resp. depression than morphine and have lower potential for abuse
80
what is the indication of codeine?
relief of mild to moderate pain
81
what route is common for codeine?
PO
82
what happens to codeine in the liver?
about 10% converts into morphine (active form of codeine)
83
what drug can you combine codeine with? why?
aspirin/acetaminophen | - combining increases pain relief
84
what effect does codeine have on coughs?
extremely effective cough suppressant
85
what other drug has the similar properties as methadone?
morphine
86
what is naloxone?
opioid agonist
87
what is the indication of naloxone?
blocks effects of opioid agonists
88
what is the action of naloxone?
structural analog of morphine that acts as a competitive antagonist at opioid receptors, therefore blocks opioid actions
89
how can naloxone be administered?
IV, IM, subQ
90
what are gabapentin and amitriptyline used for?
to complement the effects of opioids, used in combination
91
what effects can adjunctive analgesics have? (3)
1. enhance analgesia from opioids 2. help manage concurrent symptoms that exacerbate pain 3. treat SE caused be opioids
92
what are two examples of adjunctive analgesics?
gabapentin and amitriptyline
93
what type of pain are adjunctive analgesics useful for?
neurologic pain
94
what were adjunctive analgesics originally meant to treat?
depression, seizures
95
what are common antidepressants?
tricyclic antidepressants (TCA)
96
what kind of antidepressant can treat neuropathic pain?
amitriptyline
97
what are adverse effects of TCAs?
orthostatic hypotension, sedation, anticholinergic effect
98
what can antiseizure drugs also be used for?
relieve neuropathic pain
99
where is the greatest concentration of marijuana?
in the flowering tops of female plants
100
where is the lowest concentration of marijuana?
in the seeds
101
what is hashish?
dried preparation of the resinous exudate from female flowers
102
how long does it take for subjective effects of marijuana to take place?
minutes
103
when is the peak for marijuana?
10-20 mins
104
how long can effects of marijuana last?
2-3 hours
105
how much of marijuana reaches the systemic circulation when it is ingested?
only 6-20%
106
how much larger do oral doses have to be compared to smoked doses for marijuana?
3-10x greater to produce equivalent effects
107
how long is the delayed effect of oral marijuana dosing?
30-50 mins
108
what 3 subjective effects does marijuana produce?
1. euphoria 2. sedation 3. hallucinations
109
what is amotivational syndrome?
associated with excessive marijuana use - includes apathy, dullness, grooming, reduced interest in achievement, and disinterest in the pursuit of conventional goals
110
what mental health problem can marijuana increase the risk of?
schizophrenia
111
how does marijuana effect HR?
"rose-related" increase in heart rate
112
what effect can marijuana have on males?
dec. spermatogenesis and testosterone
113
what effect can marijuana have on females?
dec. levels of FSH and LH and prolactin
114
what are symptoms of marijuana dependence?
irritability, restlessness, nervousness, insomnia, reduced appetite, and weight loss
115
when do withdrawal symptoms subside with marijuana?
3-5 days (moderate users do not experience these)
116
how can marijuana help with glaucoma?
smoking can reduce intraocular pressure but may also reduce blood flow to optic nerve
117
what are some therapeutic uses for marijuana?
reduces chronic pain - suppresses nausea caused by chemo - improves appetite in patients - suppresses spasticity with MS and spinal cord injury

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